Henry Adam holds a photograph of his son Nikko when he was younger. Henry discovered that Nikko was using heroin when he was in high school. He regularly found empty heroin packets in Nikko's room and in the trash. He would save them to confront his son.

Melissa Block/NPR; Courtesy of Henry Adam

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Originally published on March 21, 2016 3:45 pm

Here's how I knew I liked Patti Trabosh.

It goes back to the very first time I called her out of the blue to ask whether I might profile her family for a story on opioid addiction. The very first words out of her mouth were, "I'm pissed off!"

Trabosh went on to explain why she was angry. First, it was the struggle to find a bed in a drug treatment program for her 22-year-old son Nikko Adam. He had become addicted to prescription painkillers and then heroin when he was still in high school. He'd been in rehab twice before, and relapsed both times.

Once she found an available treatment slot, it was the seemingly endless and maddening battles with her insurance company, trying to get them to cover Nikko's treatment.

She told me, "The bottom line is, it's easier for addicts to go get another bag of heroin than it is to get help."

I had been put in touch with Trabosh by Judy Schwank, a Pennsylvania state senator who's been deeply involved with trying to solve the opioid crisis in her state.

She led me to the Kutztown, Pa., area, to Patti Trabosh and her family. They include Brandy Trabosh, Nikko's 30-year-old sister; Mikey Roth, his 34-year-old brother; and Henry Adam, his father.

I spent time over three days talking with them about how Nikko's heroin addiction has challenged the family, in Kutztown and in nearby Hamburg. We also met Nikko near the sober living facility where he's been staying. Here are highlights of our conversation, which has been edited for length and clarity.

Interview Highlights

On how quickly heroin has taken over this rural corner of southeastern Pennsylvania

Brandy: When I went to high school there, you never heard about anything like that. None of the heroin, none of the pills, nothing. And it was like a huge shock, once I heard, like WHAT?! Where does that even come from? Where do you get that? Who would want to do that?

On losing trust in Nikko as he continued using

Brandy: For a while, when I had holidays or parties or whatever here, I had to lock everything up. I told Nikko, actually, Thanksgiving, I said, "Don't even come." 'Cause I was just at the point where, I have all these people here, I don't have time to watch and make sure that he's not stealing something, or that he's not high around my kids, or he brought heroin into my house when my kids are here. So I just said don't come.

On the family's fears that Nikko would overdose and die

Mikey: We lost him to heroin. It was only a point in time when he was going to overdose, and we knew it.

Brandy: We hear about the overdoses and we're like, "Oh! Nikko, please stop, everybody's dying!" And Nikko's lost some friends, too, to overdose. So I guess everybody feels like it's not going to happen to them. And maybe that's the reason for the hush-hush. If you don't talk about it, then it's not real.

Patti, talking to Henry: And I said that to you. I said, "We're going to bury this kid." Didn't I say that to you? Yep. I was waiting for him to call me and tell me that Nikko was gone. He should be dead! He should be dead, with all the heroin he used plus the two vehicles he totaled!

On feeling responsible for Nikko's addiction and learning to be open about it

Henry: It's a daily struggle for me. I'll never come to terms with the fact that in some way, shape or form, I'm responsible.

Patti: For a while, people would say, when it first started, they'd say, "How's Nikko?" And I'd say, "Oh, he's great." But then it just came to a point where they'd say, "How's Nikko?" And I'd say, "Oh, he's a heroin addict." And they would be — "Ah, what?" "Yeah. He's a heroin addict." And that's just how it is. Like I'm not going to hide anything anymore.

On the family's hopes that this time rehab will work for Nikko

Nikko: I'm hopeful for the future for the first time. I can actually look into the future now. I have faith now.

Patti: He's not gonna relapse, I'm tellin' you right now. He's too serious about his recovery. It's not gonna happen.

Mikey: I'm really optimistic about this time, but the whole thing with this is, if he wanted to go out and score heroin, he could do it pretty much anywhere that he goes.

This story was produced by NPR's Evie Stone.

Copyright 2016 NPR. To see more, visit http://www.npr.org/.

MELISSA BLOCK, HOST:

And now a portrait of one family's experience with opioid addiction. They represent just one dot in the map of the opioid epidemic that's engulfed this country.

NIKKO ADAM: It started, like, just every now and then in school.

BLOCK: Nikko Adam is 22 from a small town in Southeast Pennsylvania, Kutztown. Nikko got addicted to painkillers and then to heroin when he was still in high school.

N. ADAM: I started smoking weed when I was 14.

MIKEY ROTH: He was a great kid growing up. He was big into sports.

N. ADAM: It quickly progressed from that to pills.

HENRY ADAM: Prankster, funny, kind of the center of attention.

N. ADAM: Percocet, morphine, Opanas.

BRANDY TRABOSH: He's outgoing. He'll talk to anybody.

N. ADAM: Vicodin, OxyContin, which is what progressed to heroin.

PATTI TRABOSH: Super smart.

N. ADAM: Thankfully I'm afraid of needles, so I never shot it. And I think that saved my life.

BLOCK: We heard Nikko Adam, his sister, brother and parents. He's recently out of his third stint in rehab. Over the years, Nikko's addiction has catapulted the family from denial to rage, from fear to hope and back to fear.

B. TRABOSH: I'm so worried. And I try to just stay positive. Like, this is going to be the time. This is going to be the time, you know?

BLOCK: This is Nikko's older sister, Brandy.

B. TRABOSH: But there's so many other times where it just wasn't the time that you almost set yourself up for the letdown 'cause then it's not such a letdown if you expect the worst.

BLOCK: Brandy is 30. She went to Kutztown High seven years ahead of Nikko.

B. TRABOSH: When I went to high school there, you never heard about anything like that, you know? None of the heroin, none of the pills, nothing.

BLOCK: So things have really changed.

B. TRABOSH: Yeah, and I think it was, like, a huge shock, you know? Like, once I heard, like, what? Where does that even come from, you know? Where - where do you get that? Who would want to do that?

BLOCK: I meet Brandy at her house in Hamburg, Penn. She's just gotten home from her factory shift at a battery plant. Brandy tells me trust was one of the first things to go.

B. TRABOSH: For a while, when I had holidays or parties or whatever here, I had to lock everything up.

BLOCK: She'd lock up medicine, lock up any cash or valuables lying around.

B. TRABOSH: I told Nikko actually Thanksgiving, I said don't even come 'cause I was just at a point where I have all these people here. I don't have time to watch and make sure, you know, that he's not stealing something or that he's not high around my kids or he brought heroin into my house when my kids are here. So I just said don't come.

BLOCK: Nikko's addition has forced Brandy to have an early, honest conversation about drugs with her son.

B. TRABOSH: We said, you know, you learn about drugs in school and, you know, you can die from using drugs. And Uncle Nikko uses drugs, and that's why you don't see him sometimes. We just laid it out. I mean, he's 11, so how - what is the age that this whole thing starts? And I'm trying to, you know, get him ready to have to make a decision like that. That's scary. That's crazy scary for a mom.

BLOCK: Brandy tells me about the cycles her family has gone through with her younger brother, talking with Nikko, pleading with him. When one despairs or gets angry or has had enough, another will step in to pick up the pieces. And always, always, they think about the horror stories.

B. TRABOSH: Yeah, and Nikko's lost some friends to overdose. So I guess everybody feels like it's not going to happen to them. And maybe that's the reason for the hush-hush, you know? If you don't talk about it, then it's not real.

P. TRABOSH: I've never been one to hide anything or sweep anything under the carpet. Henry, you know that.

BLOCK: I meet Nikko's parents the next day, Henry Adam and Patti Trabosh.

P. TRABOSH: For a while, people would say, when it first started, they'd say how's Nikko? And I'd say, oh, he's great. But then it just came to a point where they'd say how's Nikko and I'd say, oh, he's a heroin addict. And they would be - what? I'm like, yeah, he's a heroin addict. And that's just how it is. Like, I'm not going to hide anything anymore.

BLOCK: Patti is tiny, as feisty as she sounds. She's a waitress and bartender. She and Nikko's dad are long separated but have stayed great friends. Ironically, Henry Adam works for a company that distributes pharmaceuticals, including the painkillers that led to his son's addiction. We're talking in Nikko's wood-paneled bedroom in the house where he grew up.

H. ADAM: It's almost like a house of horrors because you just don't know what to expect. There's many times I would come in the room and he'd have lines chopped out on the table.

BLOCK: Henry tells me about the times he would stay up all night with Nikko after he'd used heroin, keeping his son awake so he wouldn't die in his sleep. Henry describes himself as a classic enabler. His way of coping was to bail Nikko out, give him chance after chance. Patti also spent years trying to help Nikko, but her love was tougher. She remembers one time when she reached a breaking point. She had gotten Nikko a job at the restaurant where she waitresses and he brought heroin to work.

P. TRABOSH: And I said get out. Get out. I don't want to see you anymore. You brought it into my home, into my job. I'm done. I don't want to talk to you anymore. Just for my own sanity, I couldn't deal with it anymore, and you the same, right?

BLOCK: Here she's turned to Mikey, Nikko's older brother by 11 years. Mikey helped raise Nikko. They've always been super close. At one point, Nikko even moved in with him. But eventually Mikey had to walk way too.

ROTH: I was used up emotionally from him and I was also used up physically. Like, I didn't sleep many nights 'cause I was worried sick about him. Just tired of it at that point. And until he wants to get help for himself, like, you can't help him at this point anymore. And I said you just have to be done. I understand it's hard, but you have to mourn him like he's gone and be done with everything.

BLOCK: Mourn him like he's gone, like you've lost him.

P. TRABOSH: Yeah, yeah.

ROTH: 'Cause we did. We lost him to heroin. And it was only...

P. TRABOSH: Yeah. He wasn't Nikko.

ROTH: Yeah, it was only a point in time where he was going to overdose. And we knew it.

P. TRABOSH: And I said that to you.

ROTH: Yeah.

P. TRABOSH: I said we're going to bury this kid. Didn't I say that to you? Yep. I was waiting for him to call me and tell me that Nikko was gone.

BLOCK: For Henry to call you.

P. TRABOSH: Yes. One day, I think it was when he wrecked your truck, you called me and I said hello and he went (sighing). And I said just tell me because I thought that was the call, Henry. I thought that was the call that he was gone. He should be dead with all the heroin he used plus the two vehicles he totaled.

BLOCK: How much second guessing have you two done as parents about, you know, were we responsible? How much guilt do you bear?

P. TRABOSH: One hundred percent, 100 percent.

H. ADAM: Yeah, it's a daily struggle. I'll never come to terms with the fact that in some way, shape or form, I'm responsible.

BLOCK: When I visit the family, Nikko has been out of rehab for three weeks.

H. ADAM: So we're off?

P. TRABOSH: We're off.

BLOCK: I hop in the car with Patti and Henry to go visit Nikko at the sober living house where he'll be staying for several months. His parents have spent thousands on rehab for Nikko. He relapsed after both of his earlier stints, but they believe this time will be different. They think this latest rehab program is better. The months of sober living aftercare will be important. Most of all, they think this time Nikko wants to stop using.

H. ADAM: If he does relapse, I'd be disappointed but it's all about, like, how he reacts, like, to be able to pick up the pieces immediately and go right back the other way.

P. TRABOSH: Nope. He's not going to relapse. I'm telling you right now. He's too serious about his recovery. It's not going to happen.

BLOCK: There are drugs that can help with addiction. It's called medication-assisted treatment. And many experts feel that's the most effective path. But Nikko and his family have chosen to rely instead on a 12-step abstinence program.

P. TRABOSH: We're getting close. I can feel him.

BLOCK: We pull up to a brown lodge on a back road. And Patti just about flies out of the car...

P. TRABOSH: There he is.

BLOCK: ...When Nikko comes out.

N. ADAM: Hello.

P. TRABOSH: Nice hat.

H. ADAM: Hey, it's going good. Good to see you.

N. ADAM: You too.

BLOCK: Nikko looks and sounds sleepy. He was up late playing video games. But you can tell he's happy to see his parents. He drapes his arm around his mom. Patti can't take her eyes off him. Later that day, I talk with Nikko alone about the path of his addiction. At its worst, he would spend his whole paycheck - $450 a week - on heroin.

N. ADAM: I would get paid that on Friday. And that was usually gone by Tuesday.

BLOCK: He'd snort it all in three days. There were times he tried to detox on his own.

N. ADAM: A heroin detox feels like - like your bones are, like, trying to crawl out of your body.

BLOCK: But his addiction kept pulling him under.

N. ADAM: I just felt like I had no capacity whatsoever to love anyone or be loved anymore. Like, I had nothing left inside at all. Nothing.

BLOCK: And how do you feel now?

N. ADAM: Great. Great. I'm hopeful for the future for the first time. I can actually look into the future now. I have faith now.

BLOCK: Do you think there is anything that your parents could have done differently, Nikko?

N. ADAM: No.

BLOCK: Were they oblivious to stuff that was going on?

N. ADAM: No. You can't help someone that doesn't want to help themselves, which I see now. I mean, I feel they did everything they possibly could or tried to, you know?

BLOCK: The family has come to terms with this truth. For Nikko to beat his addiction, he can't come home to Kutztown.

H. ADAM: I think his only downfall would be to come back here

ROTH: Oh, yeah, absolutely.

P. TRABOSH: So if he has his mind set he's going to quit, it's going to be easier for him to quit somewhere else where he doesn't have all these triggers in this area.

BLOCK: And how hard is that to realize that your son won't be here where you are?

P. TRABOSH: Not hard. We'll go see him.

ROTH: He hasn't been here for a long time to me.

P. TRABOSH: Yeah.

ROTH: So for me it's - it'll be nice to actually have hope that I can go and see him somewhere else where he's actually Nikko instead of seeing the addict that I've seen for the last couple of years now.

BLOCK: And the family knows that for Nikko, staying away from opioids will be a lifelong struggle.

ROTH: I'm really optimistic about this time. But the whole thing with this is if you want to go out and score heroin, he can do it pretty much anywhere that he goes.

BLOCK: Nikko Adam will be leaving his sober living house later this spring. Transcript provided by NPR, Copyright NPR.